Blood in Urine: Insights on Bladder Cancer Concerns - Urology

Suspected bladder cancer?

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Hello Dr.
Du: I am 151675, following up on my question regarding "morning hematuria." In mid-December 2019, one morning I woke up with a dull sensation in my lower abdomen.
I went out for a brisk walk and slow jog for about 50 minutes.
After returning home, the feeling of fullness in my lower abdomen and genital area became more pronounced.
When I went to the bathroom to urinate, the urine was completely blood-red, and I felt a pressure sensation in my urethra as the urine passed.
Aside from the fullness and pressure, there was no pain like that of kidney stones (my previous experience involved severe pain in my lower back and abdomen).
I drank more water, and by around 9 AM, when I urinated again, the color was less bright red and more of a light brown.
After 11 AM, the urine was light yellow, and I could no longer see any red color.
That evening, I visited the hospital, where a urinalysis confirmed hematuria, but there were zero white blood cells.
An ultrasound of my kidneys showed no swelling, and an X-ray did not reveal any stones.
On the third day, I underwent the following tests: an intravenous pyelogram (IVP), which showed no tumors in the kidneys or urinary tract.
A cystoscopy revealed that the anterior urethra was intact, and there were no tumors in the bladder.
On the tenth day, I returned for the results of the urine cytology tests from the first two samples (the day of hematuria and the third day), which both showed no cancer cells, and the urine on the third day post-hematuria had no red blood cells.
On the fourteenth day, a urinalysis showed 0-2 white blood cells (-), 0-2 red blood cells, and negative for urine occult blood.
With zero white blood cells (indicating no urinary tract infection), normal IVP results, and no tumors found during cystoscopy (though a particularly prominent vascular distribution was noted, possibly indicating mucosal abrasion), it was inferred that a bladder stone may have abraded the bladder mucosa, leading to the hematuria.
Dr.
Du, I have a few questions and would appreciate your insights: (1) I am very curious—if it were a bladder stone, how could there be no severe pain like I experienced with kidney stones? Is this possible? (2) With gross hematuria and only a feeling of fullness during urination, in your clinical experience, have you encountered cases where bladder stones passed with hematuria but without severe pain? (3) After the cystoscopy on the third day post-hematuria, why was there no visible bleeding point? Is our mucosal cell repair that effective? (I always thought there would be clear signs of a bleeding wound.) (4) Given all the test results—ultrasound, X-ray, IVP, urine cytology, and cystoscopy—can I reasonably set aside concerns about bladder cancer? The doctors at the hospital were very kind and enthusiastic, but I was quite nervous at the time and forgot to clarify these questions, or perhaps the doctors explained things that I do not remember.
Therefore, I am reaching out to you for clarification.
Thank you very much, Dr.
Du.

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Du Fen, 50~59 year old female. Ask Date: 2020/02/16